A Systematic Review of Clinical Studies on Mucocutaneous Manifestations of COVID-19: Virus-Related and Drug-Related

Abstract

Coronavirus could affect almost any part of the body including the skin. In this systematic review, the primary skin lesions resulting from the direct activity of the virus or the medications used for treatment and the changes in the behavior of the virus regarding the occurrence of these symptoms over time were assessed. PubMed/MEDLINE, Embase, PsycINFO, TRIP Cochrane, Cochrane Skin were searched for all published articles from February 19 to July 1, 2020, which met the inclusion criteria. Thirty-six related articles were extracted. Twenty-eight studies reported virus-related mucocutaneous eruptions and 8 articles, the drug-reactions. Data of 583 patients were included. Skin lesions of COVID-19 could be caused by both the virus itself or the influence of drugs used for the treatment. Morbilliform rashes, urticaria, and acral-vasculopathic cutaneous lesions were at the forefront of primary COVID-dependent skin lesions with no significant change during time, Also, Hydroxychloroquine, lopinavir/ritonavir, paracetamol, and antibiotics were reported as the main causes of drug-induced rashes. Since dermatologic manifestations may occur prior or simultaneously/after other COVID clinical symptoms, so they may helpful in patients’ early diagnosis or prediction of internal organ involvements via histopathologic evaluations of skin biopsies especially about vasculopathic and vasculitic, respectively.

COVID‐19 and COVID‐19 vaccine‐related dermatological reactions: An interesting case series with a narrative review of the potential critical and non‐critical mucocutaneous adverse effects related to virus, therapy, and the vaccination

“…COVID‐19 vaccine‐associated mucocutaneous adverse events comprising local acute and delayed injection site reactions, non‐specific/maculopapular/morbilliform eruptions, urticaria, virus reactivations, and angioedema were scarcely reported, and despite some rare anaphylactic reactions, had excellent prognosis. 7 , 9 …”

“…In this category, two possible mechanisms have been proposed for skin involvement: (1) local direct cytopathic interactions of immune cells with the virus within the skin and mucosa and (2) Eruptions secondary to excessive immune response and cytokine release due to viremia. 8 , 9 …”

“…Sputnik V's vaccinated subjects reported acneiform rash, alopecia, allergic dermatitis, eczema, and petechial rash. 7 , 9 …”

“…When oral lisinopril was prescribed in these patients, it subsided the symptoms which pertained to the high expression of angiotensin‐converting enzyme (ACE) 2 receptors at the injected site. 7 , 9 …”

“…7 Pernio and Chilblains: erythematous and painless macules and papules on extremities occurred after inoculation, which were previously noticed with COVID‐19 patients suggesting that they share a similar immune mechanism. 7 , 9 …”